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Unloader knee brace increases medial compartment joint space during gait in knee osteoarthritis patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the present study was to investigate the effect of the unloader brace on medial compartment dynamic joint space (DJS) during gait, while simultaneously recording ground reaction force (GRF) in varus knee osteoarthritis (OA) patients using a highly accurate biplane radiography system which allowed continuous measurement of DJS from heel strike through the midstance phase of gait. The hypothesis was that DJS in the medial compartment would be greater with the unloader brace than without the brace during gait.

Methods

After 2 weeks of daily use of the unloader brace, ten varus knee OA patients (age 52 ± 8 years) walked with and without the brace on an instrumented treadmill, while biplane radiographs of the OA knees were acquired at 100 Hz. Medial compartment DJS was determined from heel strike to terminal stance (0–40% of the gait cycle) using a validated volumetric model-based tracking process that matches subject-specific 3D bone models to the biplane radiographs. The GRF during gait was collected at 1000 Hz. Repeated-measures ANOVA was used to explore differences in medial compartment DJS and GRF between the unbraced and braced conditions. A patient-reported subjective questionnaire related to the brace use was collected at the time of the test.

Results

Medial compartment DJS was significantly greater with the unloader brace than without the brace during gait (P = 0.005). The average difference was 0.3 mm (95% confidence interval 0.1–0.4 mm). No significant difference was observed in terms of vertical GRF between the two conditions. The questionnaire showed participants felt reduced pain when wearing the brace.

Conclusion

The unloader brace has the significant effect of increasing medial compartment DJS during gait, which supports the underlying premise that the unloader brace reduces pain by increasing medial joint space during dynamic loading activities.

Level of evidence

III.

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Funding

University of Pittsburgh received a research grant from DJO, Inc. DJO also provided the Defiance braces used for the study.

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Authors and Affiliations

  1. Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA, 15203, USA

    Kanto Nagai, Shumeng Yang, Freddie H. Fu & William Anderst

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Kanto Nagai

Authors
  1. Kanto Nagai
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  2. Shumeng Yang
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  3. Freddie H. Fu
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  4. William Anderst
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Corresponding author

Correspondence to William Anderst.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

The institutional review board (IRB) for human subject research in University of Pittsburgh approved all aspects of this study (ID: PRO08060104).

Informed consent

Informed consent was obtained from all patients before the enrollment.

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Nagai, K., Yang, S., Fu, F.H. et al. Unloader knee brace increases medial compartment joint space during gait in knee osteoarthritis patients. Knee Surg Sports Traumatol Arthrosc 27, 2354–2360 (2019). https://doi.org/10.1007/s00167-018-5274-y

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  • DOI: https://doi.org/10.1007/s00167-018-5274-y

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